乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者临床特征及其危险因素分析*

doi:10.3969/j.issn.1672-5069.2021.04.020

摘要/Abstract

摘要： 目的分析乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血(EVB)患者的临床特征,并探讨乙型肝炎肝硬化发生EVB的危险因素。方法 2018年6月～2020年6月我院收治的乙型肝炎肝硬化并发食管胃底静脉曲张(GOV)患者108例,当发生曲张静脉破裂出血时,给予内科止血治疗。收集临床资料,应用单因素和多因素Logistic回归模型分析确定乙型肝炎肝硬化发生EVB的独立危险因素。结果在108例乙型肝炎肝硬化并发GOV患者中,38例(35.2%)发生EVB,其中5例(13.2%)患者在发病72 h内死亡;单因素分析提示过度劳累与GOV患者发生EVB无显著的相关性(P>0.05),而饮食不当、服用非甾体类抗炎药、血小板计数(PLT)、凝血酶原时间(PT)、血清白蛋白(ALB)、门静脉内径、脾静脉内径、红色征、肝功能Child-Pugh分级和食管胃底静脉曲张程度与GOV患者发生EVB显著相关(P<0.05);多因素Logistic回归分析结果显示饮食不当【OR(95% CI)为2.2(1.3～3.7)】、门静脉内径增宽【OR(95% CI)为1.4(1.1～1.7)】、PT延长【OR(95% CI)为1.3(1.1～1.6)】、有红色征【OR(95% CI)为3.3(1.6～7.1)】、肝功能Child-Pugh C级【OR(95% CI)为3.9(1.7～9.0)】和重度食管胃底静脉曲张【OR(95% CI)为3.5(1.9～6.5)】是乙型肝炎肝硬化发生EVB的独立危险因素。结论乙型肝炎肝硬化并发GOV患者存在一些上消化道出血的原因,其中EVB是重要的致命原因。EVB发生的本身有一些危险因素,需要临床给予必要的一级和二级预防措施,以减少EVB的发生。

关键词: 肝硬化, 食管胃底静脉曲张, 曲张静脉破裂出血, 危险因素

Abstract: Objective The aim of this study was to summarize the clinical features of patients with hepatitis B liver cirrhosis (LC) complicated by esophagogastric variceal bleeding (EVB), and to explore the risk factors of EVB. Methods The clinical data of 108 patients with hepatitis B LC complicated with gastroesophageal varices (GOV) were collected in our hospital between June 2018 and June 2020, and internal medicine was given when the EVB occurred. The clinical features of patients were summarized and the independent risk factors of EVB were evaluated by univariate and multivariate Logistic regression analysis. Results Among the 108 patients with hepatitis B LC and GOV, the EVB occurred in 38 cases (35.2%) , and out of which, 5 patients (13.2%) died within 72 hours after onset of bleeding; the univariate analysis indicated that overwork was not significantly related with EVB in patients with hepatitis B LC and GOV (P>0.05), while improper diet, taking non-steroidal anti-inflammatory agents, platelet (PLT) count, prothrombin time (PT), serum albumin (ALB), diameter of portal vein and splenic vein, red-color sign, Child-Pugh class of liver functions and GOV degrees were significantly correlated with EVB happening (P<0.05); the multivariate Logistic regression analysis showed that improper diet [OR(95%CI) : 2.2 (1.3-3.7)], increased portal vein diameter [OR(95% CI:1.4(1.1-1.7)], prolonged PT [OR(95% CI:1.3(1.1-1.6)], red-color sign [OR(95% CI:3.3(1.6-7.1)], Child-Pugh class C [OR(95% CI:3.9(1.7-9.0)] and severe GOV [OR(95% CI:3.5(1.9-6.5)] were the independent risk factors of EVB in patients with LC. Conclusion The EVB is the improper cause of gastrointestinal bleeding in patients with hepatitis B-induced LC,and the common intriguing events should be dealt with early and appropriately in clinical practice to decrease the EVB occurrence.

Key words: Liver cirrhosis, Gastroesophageal varices, Esophagogastric variceal bleeding, Risk factors

江秋维, 黄理, 姚朝光. 乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者临床特征及其危险因素分析^*[J]. 实用肝脏病杂志, 2021, 24(4): 532-535.

Jiang Qiuwei, Huang Li, Yao Chaoguang. Clinical features and risk factors of esophagogastric variceal bleeding in patients with hepatitis B liver cirrhosis[J]. Journal of Practical Hepatology, 2021, 24(4): 532-535.

参考文献

[1] 古川, 徐小元, 熊辉. 肝硬化食管胃底静脉曲张的一级预防和二级预防. 实用肝脏病杂志, 2016, 19(5):513-515.
[2] Seo YS . Prevention and management of gastroesophageal varices. Clin Mol Hepatol, 2018, 24(1):20-42.
[3] Tian L, He Y, Li D, et al. Surgical shunts compared with endoscopic sclerotherapy for the treatment of variceal bleeding in adults with portal hypertension: asystematic review and meta-analysis. Postgrad Med J, 2018, 94(1107):7-14.
[4] Mansour L, El-Kalla F, El-Bassat H, et al. Randomized controlled trial of scleroligation versus band ligation alone for eradication of gastroesophageal varices. Gastrointest Endosc, 2017, 86(2):307-315.
[5] 肖勇, 于红刚, 陈明锴. 肝硬化门静脉高压食管胃底静脉曲张出血的内镜诊治策略. 中华消化内镜杂志, 2018, 35(2):84-88.
[6] Qi X, Jia J, Bai M, et al. Transjugularintrahepatic portosystemic shunt for acute variceal bleeding: a meta-analysis. J Clin Gastroenterol, 2015, 49(6):495-505.
[7] Mathur SK, Shah SR, Soonawala ZF, et al. Transabdominal extensive oesophagogastric devascularization with gastro-oesophageal stapling in the management of acute variceal bleeding. Br J Surg, 2015, 84(3):413-417.
[8] 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会消化内镜学分会. 肝硬化门静脉高压食管胃底静脉曲张出血的防治指南. 中华内科杂志, 2016, 55(1):57-72.
[9] 中华医学会消化病学分会, 中华医学会肝病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃底静脉曲张出血的防治共识(2008,杭州). 中华消化杂志, 2008, 28(8):551-558.
[10] Satapathy SK, Sanyal AJ. Nonendoscopicmanagement strategies for acute esophagogastric variceal bleeding. Gastroenterol Clin North Am, 2014, 43(4):819-833.
[11] Hwang JH, Shergill AK, Acosta RD, et al. The role of endoscopy in the management of variceal hemorrhage. Gastrointestinal Endoscopy, 2014, 80(2):221-227.
[12] Lenzen H, Musmann E, Kottas M, et al. Acute gastrointestinal bleeding cases presenting to the emergency department are associated with age, sex and seasonal and circadian factors. Eur J Gastroenterol Hepatol, 2017, 29(1):78-83.
[13] Takuma Y, Nouso K, Morimoto Y, et al. Prediction of oesophageal variceal bleeding by measuring spleen stiffness in patients with liver cirrhosis. Gut, 2016, 65:354-355.
[14] Njei B, Mccarty TR, Laine L. Early transjugular intrahepatic portosystemic shunt inUS patients hospitalized with acute esophageal variceal bleeding. J Gastroenterol Hepatol, 2017, 32(4):852-858.
[15] Rudler M, Bureau C, Carbonell N, et al. Recalibratedmeld and hepatic encephalopathy are prognostic factors in cirrhotic patients with acute variceal bleeding. Liver Int, 2018, 38(3):469-476.
[16] Reverter E, Genesca J, Augustin S, et al. Riskstratification in acute variceal bleeding: Child-Pugh versus model for end-stage liver disease. J Clin Gastroenterol, 2017, 53(7):549.
[17] 施伦波. 肝硬化患者肝功能Child-Pugh分级与血小板参数及凝血指标变化的临床相关性探究. 中华全科医学, 2015, 13(6):941-943.
[18] Li CJ, Yang ZH, Lu FG, et al. Clinical significance of fibrotic, haemostatic and endotoxic changes in patients with liver cirrhosis. Acta Gastroenterol Belg, 2018, 81(3):404-409.
[19] 张媛媛, 陈国栋, 王智峰, 等. 肝硬化患者静脉曲张出血的临床和内镜特点分析. 中华普通外科杂志, 2018, 32(2):134-137.
[20] 倪猛, 张海洋. 内镜下套扎联合硬化剂注射治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者疗效及其再出血危险因素分析. 实用肝脏病杂志, 2018, 21(2):241-244.
[21] Bai M, Qi X, Yang M, et al. Combined therapies versus monotherapies for the first variceal bleeding in patients with high-risk varices:a meta-analysis of randomized controlled trials. J Gastroenterol Hepatol, 2014, 29(3):442-452.
[22] Lyu Y, Zuo L, Zhu X, et al. Identifying optimal candidates for early tips among patients with cirrhosis and acute variceal bleeding: a multicentre observational study. Gut, 2018, 68(7):1297-1310.
[23] Hu Z, Li Y, Li C, et al. Usingultrasonic transient elastometry (fibroscan) to predict esophageal varices in patients with viral liver cirrhosis. Ultrasound Med Biol, 2015, 41(6):1530-1537.

乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者临床特征及其危险因素分析^*

Clinical features and risk factors of esophagogastric variceal bleeding in patients with hepatitis B liver cirrhosis

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